Vaping- related injury and illness among Canadian children and

ChadiN, etal. BMJ Paediatrics Open 2020;4:e000840. doi:10.1136/bmjpo-2020-000840

Open access

Vaping- related injury and illness

among Canadian children and

adolescents: a one- time survey of

paediatric providers

Nicholas Chadi ,

Charlotte Moore- Hepburn,

Suzanne Beno,

Sarah A Richmond

To cite: ChadiN,

Moore- HepburnC, BenoS, etal.

Vaping- related injury and illness

among Canadian children

and adolescents: a one- time

survey of paediatric providers.

BMJ Paediatrics Open

2020;4:e000840. doi:10.1136/

bmjpo-2020-000840

Received 12 August 2020

Accepted 3 October 2020

Division of Adolescent

Medicine, Department of

Paediatrics, Sainte- Justine

University Hospital Centre,

Montreal, Québec, Canada

Division of Paediatric Medicine,

Department of Paediatrics,

The Hospital for Sick Children,

Toronto, Ontario, Canada

Division of Emergency

Medicine, Department of

Paediatrics, The Hospital for

Sick Children, Toronto, Ontario,

Canada

Dalla Lana School of Public

Health, University of Toronto,

Toronto, Ontario, Canada

Correspondence to

Dr Nicholas Chadi; nicholas.

chadi@ umontreal. ca

Original research letter

employer(s)) 2020. Re- use

permitted under CC BY- NC. No

commercial re- use. See rights

and permissions. Published by

BMJ.

ABSTRACT

A one- time survey distributed to 2693 Canadian

paediatricians enrolled in the Canadian Paediatric

Surveillance Programme was conducted between

October and December 2019. We identied a wide range

of severe vaping- related injuries and illnesses among

children ages 0–17 (n=88), which were associated with

the routine use or malfunctioning of a vaping device or

the ingestion of vaping substances. The most common

clinical presentations were acute respiratory symptoms

and nicotine toxicity and 15% (n=13) of injuries required

intensive care unit admission. Our study highlights the

urgent need for substantive policy measures to help

protect youth against the risks associated with vaping

products.

Recent increases in rates of vaping and

exposure to vaping devices

have resulted

in an increase in vaping- related injuries and

illnesses, often in youth.

Yet, knowledge

about the incidence, characteristics and

circumstances of these events among chil-

dren and adolescents remains limited.

All practising paediatricians and paediatric

subspecialists (n=2693) participating in the

Canadian Paediatric Surveillance Programme

(CPSP), representing approximately 95% of

practising paediatric providers in Canada,

were invited to complete a one- time online

or paper survey

between October and

December 2019. Participants were asked to

provide case- level data for patients under 18

years of age who sought medical attention in

the past 12 months for serious illnesses and/

or injuries related to one of three mecha-

nisms: (1) routine use of a vaping product,

(2) ingestion of vaping substances and (3)

malfunction of a vaping device. Descriptive,

aggregate data are reported as requested by

CPSP policy stating that case numbers and

data elements for fewer than five cases cannot

be presented (to maintain confidentiality).

There was no patient or public involvement

in this study.

The survey response rate was 42%

(1131/2693) and included respondents from

all Canadian provinces and territories. Of the

88 reported cases, there were 13 cases related

to the ingestion of vaping substances, and the

remainder were related to the routine use or

malfunctioning of a vaping device (table 1).

Forty- eight cases (55%) were male, and two-

thirds (n=58, 66%) occurred in adolescents

aged 15–17 years old. The most common

presentation was respiratory distress/lung

injury (n=39, 44%). Twenty- two cases (25%)

were treated on a hospital ward; 13 cases

(15%) required intensive care unit admis-

sion. Harms associated with ingestion of

vaping products included nicotine toxicity,

abdominal pain and nausea/vomiting.

Our survey identified a broad range of

serious vaping- related injuries and illnesses.

Injuries from routine use of a vaping device

and resulting in respiratory distress or lung

injury were the most common, and several

cases required admission to a hospital ward

or intensive care unit.

In 2019, 31.7% of Canadian high- school

students reported vaping in the past 30 days.

Initially presented as a less harmful alterna-

tive for adult smokers, vaping products are

now more commonly used by youth—many

of whom have never used tobacco prod-

ucts.

Over 2800 hospitalised cases of vaping-

associated lung injury (VALI) were reported

between August 2019 and February 2020 in

the USA, 15% of whom were adolescents ages

13–17 years.

In Canada, only 19 cases (5 cases

under age 20) had been publicly reported

by March 2020.

Our survey, which includes

cases of vaping- related injuries that presented

before the term VALI was defined, suggests

that acute lung injuries only represent a

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ChadiN, etal. BMJ Paediatrics Open 2020;4:e000840. doi:10.1136/bmjpo-2020-000840

Open access

subset of acute vaping- related harms seen in children

and adolescents.

Legislative and policy changes limiting youth access to

vaping products are at different stages of implementation

worldwide. Nonetheless, in most parts of Europe and

North America, vaping products remain easily accessible,

even for underage youth.

The 13 cases requiring inten-

sive care admission captured by our survey emphasise the

health burden associated with vaping- related injuries.

Our study has limitations. Survey participants only

included paediatric providers; therefore, results do not

include cases managed by non- paediatricians. In addi-

tion, data collection relied on voluntary reporting which

resulted in a low- to- moderate response rate (42%) subject

to non- response bias and recall bias given the 12- month

reporting period.

Our study provides key insights about acute harms

associated with vaping product exposure among children

and adolescents. These insights highlight the urgent

need for substantive policy measures to help mitigate the

risks associated with vaping products.

Twitter Nicholas Chadi @nicholaschadi and Sarah A Richmond @Sarah_A_

Richmond

Acknowledgements The study team would like to thank the paediatricians and

paediatric subspecialists who participated in this study.

Contributors NC participated in the conceptualisation and design of the study,

conducted data analyses and drafted the initial manuscript. CM- H, SB and SAR

critically reviewed the manuscript for important intellectual content. All authors

participated in the conceptualisation and design of the study, in data interpretation

and approved the nal manuscript as submitted and agree to be accountable for all

aspects of the work.

Funding This study was supported by the Canadian Paediatric Surveillance

Program a joint program of the Canadian Paediatric Society and the Public Health

Agency of Canada. The Canadian Paediatric Surveillance Program supported the

design and conduct of the study as well as collection and management of the data.

Disclaimer The funders had no role in the analysis, and interpretation of the data;

preparation, review or approval of the manuscript; and decision to submit the

manuscript for publication.

Competing interests No, there are no competing interests.

Patient and public involvement Patients and/or the public were not involved in

the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication Not required.

Ethics approval This study was exempt from research ethics approval as a public

health surveillance project collecting only aggregate and anonymous data.

Provenance and peer review Not commissioned; externally peer reviewed.

Open access This is an open access article distributed in accordance with the

Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which

permits others to distribute, remix, adapt, build upon this work non- commercially,

and license their derivative works on different terms, provided the original work is

properly cited, appropriate credit is given, any changes made indicated, and the

use is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

ORCID iD

NicholasChadi http:// orcid. org/ 0000- 0003- 1033- 2327

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Table 1 Characteristics of children and adolescents with

vaping- related injuries or illnesses

Female Male Total

Total 40 48 88*

Age range (years)

1–14 12 18 30

15–17 28 30 58

Injury mechanism

Routine use of vaping device

or device malfunction

32 43 75

Ingestion of vaping product† 8 5 13

Substance‡

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Nicotine 14 19 33

Cannabis 6 15 21

Unknown 17 16 33

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Referred to specialist * * 5

No response 10 13 23

Patient outcome

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Ongoing health issues 9 7 16

Unknown 5 8 13

No response 10 14 24

*There were no duplicate cases.

†Fewer than ve cases of injuries caused by the ingestion of a

vaping product required intensive care unit admission.

‡Respondents could select more than one option.

§Asterisk indicates that one or both sex subgroup cells contain

fewer than ve participants (exact number may not be disclosed

due to condentiality concerns).

¶Other symptoms included: injury to upper limbs or torso, head

or neck burn, eye injury/vision loss, and other (unspecied).

**Of the cases requiring intensive care unit admission, fewer

than ve had ongoing health issues.

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Open access

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